J. Liang3, N. Fitzgerald2, S. Ahmed1, D. Hiller1, J. Bohl1, C. J. Clark1 1Wake Forest Baptist Health,Department Of Surgical Oncology,Winston Salem, NC, USA 2Wake Forest Baptist Health,Public Health Sciences,Winston Salem, NC, USA 3Wake Forest School Of Medicine,Winston Salem, NC, USA
Introduction:
Colorectal cancer survivorship has improved significant over the last 20 years due to earlier detection through screening programs and better multimodality treatment options. Few studies have evaluated the health-related quality of life (HRQOL) for colorectal cancer patients and the long-term risk of major depressive disorder (MDD) among survivors. The current study hypothesizes that lower socio-economic status (SES) increases the risk of major depression among colorectal cancer survivors.
Methods:
A population-based cohort study was conducted based on linkage data from the Surveillance, Epidemiology, and End-Result registry and the Medicare Health Outcome Survey (SEER-MHOS). Patients with pathology confirmed and resected colorectal cancer over 65 years who completed a survey after diagnosis were identified in the SEER-MHOS. Survey respondents with a VR12 mental component score (MCS) less than 42 and positive depression screen were defined as patients with MDD. Using univariate and multiple variable analyses, patients with and without MDD were evaluated to identify risk factors for MDD.
Results:
1783 resected colorectal cancer patients (median age 77, 50.8% female) were identified in the SEER-MHOS dataset. The majority of patients were white (n=1337, 75%) and Stage II (n = 603, 43%). Median time from diagnosis to last follow-up was 130 months with median time from diagnosis to survey of 62 months. In this cohort, 278 (15.6%) had MDD. On univariate analysis, risks factors for MDD included female sex, non-white race, less than high school education, income less than $30,000 per year, no home ownership, more than two comorbidities, and inability to perform more than two out of six activities of daily living (ADLs) (all p < 0.05). Larger tumor size and advanced cancer stage did not predict MDD. After adjusting for comorbidities, ADLs, and time from diagnosis to survey, income less than $30,000 per year (OR 1.5, 1.02-2.22 95% CI, p = 0.042) and non-white race (OR 1.51, 1.05-2.17 95% CI, p =0.0259) were independent predictors of MDD.
Conclusion:
In the current study, lower socioeconomic status, specifically patient income, is associated with major depressive disorder among colorectal cancer survivors.